Loyalist Lancers Summer Camp

Camper's Name - First and Last *

Date of Birth (please remember to change the year) *

Gender *

Parent/Legal Guardian's Name *

Email address *

Address *

City *

Postal Code *

Phone # *

Camp: *

T-shirt Size *

*these will be reversible jerseys for basketball weeks

List any medical conditions (allergies, asthma, etc.)

Warning of Risk *

Despite careful and proper preparation, instruction and equipment, there is a still a risk of injury when participating in any recreational activity. Parents/guardians of campers must understand that certain risks and injuries due to acts of God, inclement weather, slipping, falling, and all other circumstances inherent to recreational activities/programs exist.

I understand and accept

Loyalist Lancers Sports Camp Release Form *

By checking the box below and by having your child register and participate in this camp, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which your child/ward might sustain as a result of participating in any and all activities associated with this camp. I desire my child to participate in all Loyalist camp activities, and assume all risk of any and all injuries, damages or loss my child sustains as a result of said participation. This includes my child participating in outdoor activity sessions and all regular camp activities. I agree to waive and relinquish all claims my child/ward may have as a result of participating in this camp against Loyalist College/Loyalist Lancers Sports Camp, including its officials, agents, volunteers and employees.

I understand and agree

Authorization for Publicity Release *

I hereby grant formal permission to Loyalist College/Loyalist Lancers Sports Camp to use photos and or videos for various media or marketing purposes. (i.e. local newspapers, Loyalist College Open House display, etc.) Note: Full names of children will not be used without express written permission.

Yes No

* required field